Journal of Education and Health Promotion

Abstract The COVID‑19 pandemic has had considerable consequences in many areas of life, including the
social area and childbearing plans. The present narrative review aimed to examine the childbearing
decisions and its related factors during the COVID‑19 pandemic. This review was conducted by
searching in scientific databases, including Web of Science, Science Direct, Google Scholar, Scopus,
Cochrane, PubMed, ProQuest, Scientific Information Database (SID), Iranian Research Institute
for Information Science and Technology (IranDoc) and Iranian Journal Database (Magiran) in June
2022. The search resulted in 111 sources, of which 16 were in line with the research objective.
Couples have mainly cancelled or delayed their previous plans related to childbearing decisions.
There are two groups of direct and indirect factors related to childbearing decisions during the
COVID‑19 pandemic: The former includes (1) well‑being‑related factors such as economic conditions,
interpersonal relationships and gender roles in terms of task division; and (2) health‑related factors,
including health emergencies and physical and psychological health. The latter includes factors such
as social distancing and social media. Based on the results, governments should facilitate childbearing
by adjusting existing policies, addressing economic insecurity and protecting the livelihoods of
those affected by the crisis. Health policymakers and planners must also prioritize women’s access
to reproductive health services in a safe environment while promoting equity in access. It is also
necessary to promote the quality and quantity of indirect care and virtual counseling based on the
needs of women in crisis.

Abstract BACKGROUND: Caring for a family member with cancer is a challenging issue for families. Family
caregivers often need the help of supportive resources to solve problems in their care role. A deep
understanding of the requirements of caregivers to seek help is an effective step toward their ability
to use supportive resources. This study aimed to identify and describe the requirements for promoting
help‑seeking behaviors in Iranian family caregivers of cancer patients.
MATERIALS AND METHODS: This qualitative study was conducted through in‑depth semi‑structured
interviews with 28 participants selected using purposeful sampling method from 2019 to 2021. An
interview guide with general questions about seeking help was used to maintain coherence in data
collection. The interviews continued until data saturation. All interviews were recorded, transcribed
and analyzed through qualitative content analysis.
RESULTS: The requirements of promoting help‑seeking behaviors in family caregivers
were grouped into four main categories: (1) improving social paths toward seeking help, (2)
spiritual‑psychological‑cognitive empowerment toward seeking help, (3) strengthening the motivations
behind seeking help, and (4) modifying the perception of cultural barriers to seeking help.
CONCLUSION: According to the results of this study, it is expected that by identifying the requirements
of caregivers for seeking help and by health stakeholders designing comprehensive programs to
address these needs, caregivers will be empowered to use supportive resources and provide a
better care role.

Abstract BACKGROUND: Women undergoing breast cancer treatment, especially those of reproductive age,
experience sexual health challenges. The aim of this study is to design an interventional program
for promoting the sexual health of women undergoing breast cancer treatment.
MATERIALS AND METHODS: This is a mixed qualitative‑quantitative exploratory study consisting
of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian
women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will
be selected using purposive sampling method and the data will be collected through semi‑structured
interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase,
the initial version of the program will be designed based on the results of qualitative study and review
of literature, the appropriate strategies are prioritized by the members of the panel of experts, and
then, the final interventional program is prepared. In the fourth phase, the designed interventional
program will be conducted as a quasi‑experimental study in two groups of intervention and control
and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function
of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be
selected based on the results of the previous phases and the opinion of the expert panel.
CONCLUSIONS: The results of this study are expected to contribute to the design of an interventional
program based on the needs of women undergoing breast cancer treatment and promote health and
meet the sexual health needs of breast cancer patients.

Abstract BACKGROUND: Patient‑centered care (PCC) is a key component of high‑quality care. Given the 
different effects of cancer on patients, patient‑centeredness is very important in oncology nursing 
care. The aim of this study was to explore nurses’ perceptions of the patient‑centered in oncology 
nursing care.
MATERIALS AND METHODS: This descriptive qualitative study was conducted in 2018–2020, Iran. 
Data collection methods included observation and semi‑structured interviews. Patient, family, and nurse 
behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing 
managers (12 interviews). Data analysis was performed using Graneheim and Lundman’s approach.
RESULTS: Data analysis resulted in the emergence of four themes: “Organizational structure as 
a barrier to the PCC,” “Lack of institutionalization of PCC in nurses,” “Understanding and paying 
attention to the patient as PCC,” and “Situational PCC.” The final theme of this study is “PCC in the 
shadow of paternalism.”
CONCLUSIONS: The paternalism approach in the context of oncology nursing care has made the 
realization of PCC difficult. The first step to promote PCC is increasing nurses’ awareness of the impact 
of paternalism on patient‑centeredness. Providing patient‑centered oncology nursing care requires 
changing attitudes, values, and behaviors at individual, professional, and organizational levels.

Abstract BACKGROUND: One of the most basic life events is fertility or reproduction, which, although known 
as a social phenomenon, is a complex and multidimensional concept with economic, cultural, political, 
and religious significance. The present study aims to explain the pattern of childbearing behaviors 
in couples.
MATERIALS AND METHODS: This study is a focused ethnographic qualitative research. Participants 
of this study will be 20–35 years old couples who, using purposeful sampling method, will be selected 
from comprehensive health centers, ultrasound centers, laboratories, premarital counseling centers, 
offices of obstetricians and midwives, universities, shopping centers, cinemas, parks, restaurants, 
and entertainment centers in Isfahan, Iran. Sampling will continue considering the strategy of 
maximum variation in terms of age, occupation, education, and economic status until data saturation 
is reached. Data will be collected through semi‑structured and in‑depth individual interviews, focus 
group discussions, observation, field notes, daily notes, and document analysis. Simultaneous with 
data collection, the data will be analyzed using the thematic analysis method based on Braun and 
Clarke’s approach.
CONCLUSION: This present study is expected to lead to a deep understanding and identification of 
the attitudes, beliefs, and values of couples with regard to childbearing. Moreover, by understanding 
the pattern of childbearing behaviors of couples, useful information will be provided to the policymakers 
and planners for effective planning in the field of healthy childbearing. The findings can also be used 
in reproductive health counseling for newly married couples and community‑based interventions.

Abstract BACKGROUND: Although the work environment of oncology nurses is highly complex and
challenging, their occupational health needs are scarcely studied. This study aimed to explore the
occupational health needs of oncology nurses.
MATERIALS AND METHODS: This qualitative descriptive study was conducted in 2018–2019. The
participants consisted of 52 oncology nurses and 11 other key informants. They were chosen from
eight cancer treatment centers in different cities of Iran. Data were collected through semi‑structured
individual interviews and analyzed using conventional content analysis.
RESULTS: The occupational health needs of oncology nurses were grouped into three main
categories included needs for self‑care, development of professional competency, and a safe and
healthy work environment.
CONCLUSION: The work environment of oncology nurses needs to be optimized in terms of physical,
psychological, organizational, and sociocultural conditions. Furthermore, the necessary measures
should be taken to encourage oncology nurses to implement self‑care, thus creating the preparedness
to face the challenges of the workplace by developing their professional competencies.

Abstract CONTEXT: An increasingly common complaint of staff nurses in hospitals is not receiving respect.
One of the strategies to create a healthy and positive work environment is to strengthen the respectful
behaviors among nurses.
AIMS: This study aims to explore the barriers of respect in nursing workplace.
SETTINGS AND DESIGN: This qualitative content analysis was carried out at the School of Nursing
and Midwifery of Golestan University of Medical Sciences.
SUBJECTS AND METHODS: The semi‑structured interview method was employed in this qualitative
study on 14 nursing staff in 2018. We transcribed the interviews verbatim and analyzed them using
the conventional content analysis approach.
RESULTS: Data analysis led to the emergence of 377 primary codes, 13 categories, and 4 themes.
The four themes were as follows: (a) feeling of ignored; (b) socio‑cultural conditions in society;
(c) lack of Support by Managers; (d) poor organizational climate.
CONCLUSIONS: Nursing managers can promote a healthy work environment in the nursing workplace
through recognizing these challenges and applying mitigation strategies and take benefits of their
consequences such as self‑efficacy, self‑confidence, and organizational commitment.

Abstract INTRODUCTION: Breast cancer is the most common cancer in women. It can be diagnosed in
the first stage by screening. One of the methods for screening breast cancer is mammography.
Mammography as a health behavior needs education. The theory of planned behavior examines
the factors associated with the behavior.
AIM: This research was conducted to compare the individual and peer education on the constructs
of the theory of planned behavior in mammography.
METHODS: This study was a clinical trial. A total of 100 women who attending the selected health
centers of Isfahan city were classified randomly into two groups: peer and individual education.
Education was based on the constructs of the theory of planned behavior (attitude relative to the
mammography behavior, subjective norms, perceived behavioral control, and behavioral intention).
The data were collected using a researcher‑made questionnaire. Data were analyzed using
descriptive‑analytical statistics.
RESULTS: The mean score of attitude toward behavior in the individual education group was
significantly higher than peer education (P < 0.05). In addition, the average score of subjective norms
in peer education group was significantly higher than individual education (P < 0.05). The mean
scores of perceived behavioral control constructs and behavioral intention were not significantly
different (P > 0.05).
DISCUSSION: The results of this study showed the effectiveness of education (individual and peer)
based on the theory of planned behavior on attitude toward behavior, subjective norms, perceived
behavioral control, and behavioral intention related to performing mammography in women. It seems
that using educational intervention can be useful to promote the screening behaviors of breast cancer.
In general, there were no significant differences between the two methods in changing theoretical
constructs.

Abstract Background: Multiple sclerosis (MS) is a chronic disease prevalent in young and middle‑aged
people. Patients with MS often have numerous complicated needs and, consequently, require
a broad range of health services. Results of a number of studies indicate that patients’ needs
are only partially met. Aims: This study was conducted to explore the challenges of healthcare
delivery to patients with MS in Iran. Materials and Methods: In this qualitative case study,
43 participants selected through purposeful sampling were interviewed using semi‑structured
method in the cities of Isfahan and Tehran in 2012–2013. Besides the interview, documentations
relevant to healthcare delivery were collected from different sources, including websites of
all Iranian universities of medical sciences, insurance organizations, patients’ weblogs, news
agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were
analyzed through the constant comparative analysis. Results: The data were categorized
into four main categories, including functional challenges (diagnosis problems, failure to
pay attention to patient needs, failure to follow‑up, and miscommunication), administrative
challenges (resource allocation and supervision), policy‑making challenges (lack of
comprehensive services, bureaucracy, and problems in provision of medications), and structural
challenges (difficult access to services, lack of comprehensive centers, space limit, and long
wait). Conclusion: Despite all attempts of governmental and nongovernmental organizations
for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients.
In this regard, service providers and administrators should pay more attention to the needs
and expectations of patients and their families.

Abstract Introduction: Health and healthy human being as a core concept of nursing have attracted
considerable attention in the Western literature but have received less attention in the context
of Eastern philosophy contexts. Methods: This study was done based on philosophical inquiry;
this method could be accomplished by means of different approaches like philosophical analysis
through concept analysis. There are different methods for concept analysis. Mors’s method
was employed to analyze the concept of health and healthy human being, we sought to clarify
them according to ideas deriving from the Islamic thought. To achieve the research objective,
Islamic texts were studied and analyzed based on the criteria of concept analysis (definition,
attributes/characteristics, and beaneries). Results: Our analysis revealed in the Islamic
thought human being is an integrated entity. Therefore, his health not only consists of each
single dimension, but also the full health together with the health of society gets meaning in
a balanced and coordinated set. Conclusion: Based on the results, in this study, there are
a series of similarities and differences with the perspectives of health in Islamic thought and
holism paradigm available in nursing.

Abstract Context: Breast cancer is the most common cancer among Iranian women. Although survival
rate of breast cancer patients has been increased some distresses affect the patients’ quality
of life negatively. the effectiveness of self‑care education, particularly in the sociocultural
context of Iran, has not been adequately investigated. Aims: This study aims at evaluating
the effectiveness of nurse‑led self‑care education program on quality of life in this patients.
Settings and Design: A controlled trial as pretest and posttest design was conducted in
Sayyed‑Al‑Shohada Hospital in Isfahan in 2012. Materials and Methods: Sixty patients with
breast cancer were assigned to either the nurse‑led self‑care education program (n = 30),
or to routine care (n = 30). Quality of life was measured at the time of recruitment and also
3 months after the intervention by the instrument of the National Medical Center and Beckman
Research Institute. Statistical Analysis Used: Data were analyzed by SPSS (version 16)
software using T‑independent, T‑paired and 2
, and Fisher’s exact tests. Results: The
intervention group had significantly greater improvements in quality of life status (P < 0.05).
Furthermore, self‑care education caused a significant increase in the quality of life score related
to physical (P = 0.00), psychological (P = 0.00), social (P = 0.00), and emotional (P = 0.00)
dimensions. Conclusions: Quality of life in patients with breast cancer can be improved by
participating in a nurse‑led self‑care education program. It is suggested that self‑care education
to be added to the routine nursing care delivered to these patients.

Abstract Introduction: Traumatic events such as breast cancer along with negative effects on patients
also have positive effects. These cases have been studied less in Iran. Therefore, this study
was conducted with the aim of explanation of positive changes after breast cancer by using a
qualitative approach. Materials and Methods: This qualitative study was conducted in 2012 in
one of the specialized centers for cancer affiliated to Isfahan University of Medical Sciences.
In this study, it was interviewed with 19 women with breast cancer about positive changes
after cancer by using individual, open and deep methods. The interviews were analyzed
with conventional content analysis method. Results: The titles of the three major categories
were included as behavioral changes to maintain and promote health (acquisition of health
information and adopting promoting health behaviors), spiritual development (attention to the
God and sense of meaning in life, revising the values and priorities, strengthening moral and
behavioral traits) and personal growth and flourish (feeling empowerment, confidence and
efforts to achieve the goals and desires). These three categories have led to emerge themes
in this study as the “Awakening after cancer.” Conclusions: The results of this study indicated
positive changes after breast cancer. Considering such changes while providing care and
consulting to patients with breast cancer in addition to facilitate and accelerate positive changes
will be prompted to provide care and proper and influential consulting to promote patient health.

Abstract Background: Although 25‑33% of patients with non‑hematological malignancies suffer from
depression disorder, some studies have reported the rate among patients with leukemia as
high as 50%. Furthermore, based on studies chronic disease such as leukemia increases the
patients’ spiritual needs and may accelerate the patient problems. Therefore, spirituality has
a significant role in adapting to leukemia and coping with its consequent mental disorders
such as depression. Owing to the spirituality aspect importance and contradictory results of
previous research, this study was hence performed to determine the effects of a spiritual care
program on depression of patients with leukemia. Materials and Methods: This randomized
clinical trial was conducted in specialized cancer treatment center affiliated to Isfahan
University of Medical Sciences (Isfahan, Iran). A total of 64 adult patients with leukemia were
randomly divided into experiment and control groups. The spiritual care program including
supportive presence and support for religious rituals was implemented for 3 days. Depression
sub‑scale of 42‑item depression, anxiety and stress scale‑42 was completed before and after
the intervention for both groups. Data was analyzed using ANCOVA, Mann‑Whitney U‑test,
Chi‑square, in SPSS statistical software (version 18, SPSS Inc., Chicago, IL). Results: After
the intervention, mean score of depression was significantly lower in the experiment group
than in the control group (P < 0.01). Comparison the mean score of depression in two groups,
revealed the decrees in mean score of depression 11.09 (8.47) after spiritual care program
that it was significant (P < 0.001). Conclusion: Our spiritual care program could successfully
decrease depression level in patients with leukemia and nurses have to apply a holistic care
approach with emphasis on spiritual care to decrease depression, so paid attention to spiritual
aspect of patients accompanying with physical aspects in therapy process is recommended.

Abstract Introduction: One of the important criteria in the promotion of faculty members is in the scope of
their educational roles and duties. The purpose of this study was the assessment of reasonability
and attainability of educational criteria for scientific rank promotion from the perspective of
the faculty members of Medical Sciences Universities in Iran. Materials and Methods: This
descriptive study was conducted in 2011 in 13 Universities of Medical Sciences in Iran. Through
stratified sampling method, 350 faculty members were recruited. A questionnaire developed by
the researchers was used to investigate the reasonability and attainability of educational criteria
with scores from 1 to 5. The self-administered questionnaire was distributed and collected
at each university. The mean and standard deviation of reasonability and attainability scores
were calculated and reported by using the SPSS software version 16. Results: Faculty members
considered many criteria of educational activities reasonable and available (with a mean score
of more than 3). The highest reasonability and attainability have been obtained by the quantity
and quality of teaching with the mean scores (3.93 ± 1.15 and 3.82 ± 1.17) and (3.9 ± 1.22
and 4.13 ± 1.06) out of five, respectively. The mean and standard deviation of total scores of
reasonability of educational activities were 50.91 ± 14.22 and its attainability was 60.3 ± 13.72
from the total score of 90. Discussion and Conclusion: The faculty members of the Universities of
Medical Sciences in Iran considered the educational criteria of promotion moderately reasonable
and achievable. It is recommended to revise these criteria and adapt them according to the mission
and special conditions of medical universities. Furthermore, providing feedback of evaluations,
running educational researches, and implementing faculty development programs are suggested.

Abstract Introduction: The prevalence of breast cancer among women in compare to other types of
cancers in all over the world and in Iran is high. Mastectomy surgery is one of the common
treatments for these patients. Another method, which is less invasive, is Lumpectomy. This
study comprised the satisfaction of patients under two types of surgery; Mastectomy and
Lumpectomy. Materials and Methods: In this cross-sectional study, two types of patients which
had either, Mastectomy or Lumpectomy, were studied. Results: From 119 patients which studied
here, 80 patients (66.7%) were treated by mastectomy and 39 patients (32.5%) were treated
under lumpectomy. Two groups had not significant differences in duration between diagnostic
and surgery, the number of lymph nodes involved and the number of lymph nodes removed.
Lumpectomy patients had higher pain and numbness in 24 h, 1 week after surgery and at the time
of study than the other group. The observed difference was significant (P = 0.043). Discussion:
It is implied in previous studies that patients under lumpectomy had more satisfaction than
patients under mastectomy. However, no differences were observed in quality-of-life between
the two groups in some other studies. The differences between various studies might be for the
sake of cultural variety and time interval between surgery and filling questionnaire.